Assessment of Submucosal Invasion in Gastric Cancer―Therapeutic Consideration for Minimal Submucosal Invasion (sm1) Akio Yanagisawa 1 , Tomoya Utsude 1 , Yo Kato 1 1Department of Pathology, Cancer Institute, Japanese Foundation for Cancer Keyword: 胃癌 , sm胃癌 , 内視鏡治療 pp.15-19
Published Date 1997/1/25
DOI https://doi.org/10.11477/mf.1403104944
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 In diagnosis of carcinoma with submucosal invasion, it is essential to confirm cancer cells or nests infiltrating beyond the lamina muscularis mucosae (m.m.). However, its judgment is sometimes difficult in examination of EMR materials, because of direction of cutting and/or artificially or pathologically disorganized m.m. In such cases, the existence of cancer cells or nests around or by arterioles larger than 100 μm in diameter suggests strongly the submucosal invasion. In case where a carcinoma falls into a lymph follicle in which the m.m. is usually lacking, the invasion depth is decided by a reference m.m. estimated from levels of m.m. existing in both sides of the follicle. A mucus nodule without cancer cells or nests should be considered as a part of carcinoma. When it exists in the submucosal layer, a diagnosis of submucosal invasion should be given.

 In these days, submucosal invasion of carcionma has been divided into three according to grade of invasion depth: sm1, sm2 and sm3. From a standpoint of EMR treatment, the invasion depth sm1 should be properly defined as a depth unassociated with lymph node metastasis. For carcinomas of differentiated type, a range 300 μm from the lowest line of the m.m. corresponded to above mentioned sm1, which is well comparable with that for colorectal carcinomas. However, in case of undifferentiated type carcinomas, such sm1 as to be cured by EMR could not be set because of a risk of lymph node metastasis.

Copyright © 1997, Igaku-Shoin Ltd. All rights reserved.


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